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Published on: September 26, 2018
Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk
Thomas A Gaziano1, Ankur Pandya, Krisela Steyn
1Divisions of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. tgaziano@partners.org
Insights
A simple, non-laboratory cardiovascular disease (CVD) risk score effectively identifies high-risk individuals in South Africa. This low-cost screening tool offers similar results to complex laboratory-based methods, improving primary CVD prevention accessibility.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) prevention guidelines rely on absolute risk scores.
- Laboratory testing for CVD risk is challenging in low- and middle-income countries.
- South Africa faces practical limitations in implementing laboratory-based CVD risk assessments.
Purpose of the Study:
- To compare the ranking performance of a non-laboratory-based CVD risk score against established laboratory-based scores.
- To evaluate the effectiveness of a simple risk score in diverse South African populations.
- To assess the feasibility of accessible CVD risk screening in resource-limited settings.
Main Methods:
- Compared 10-year CVD risk calculations for 14,772 adults across 13 South African populations.
- Assessed risk characterization using Spearman rank correlation against six laboratory-based scores (Framingham, SCORE, CUORE).
- Calculated national CVD mortality risk burden using the 1998 South African Demographic Health Survey.
Main Results:
- Non-laboratory score showed high correlation (0.88–0.986) with laboratory-based scores.
- 90-97% of individuals were equivalently classified as high or low risk compared to Framingham (2008).
- Approximately 18% of adults in the DHS population had high 10-year CVD death risk (>20%).
Conclusions:
- A simple, non-laboratory CVD risk score demonstrates high correlation with standard laboratory methods.
- This accessible screening approach is effective for primary CVD risk assessment in South Africa.
- Low-cost screening tools can provide comparable risk assessment to resource-intensive methods, enhancing CVD prevention strategies.
Background:
All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations.
Methods:
We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as 'high' or 'low' risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk.
Results:
Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as 'high' or 'low' risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as 'high CVD risk' (10-year CVD death risk >20%) using the non-laboratory-based score.
Conclusions:
We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.
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